NSG3RDP Semester One 2023
SCHOOL OF NURSING & MIDWIFERY
NSG3RDP/RDM – Recognising and Responding to the Deteriorating
Patient Assessment activity 2 – 2000 words (30% of overall subject
mark) Due date: May 8th 2023
Subject Intended Learning Outcomes (SILOS)
1. Explain common pathophysiology, as it relates to assessment data and pharmacology, that can
result in deterioration of an individual’s condition in order to develop appropriate interventions.
2. Apply the clinical reasoning cycle to provide person-centred care for individuals experiencing a
deterioration in health in order to provide safe nursing care.
3. Develop an awareness of and contribute to the risk management strategies of a healthcare
agency, in order to implement incident reporting procedures and apply risk management
procedures.
Context
Serious adverse events, such as unexpected death, intensive care admission and cardiac arrest, are
often preceded by observable physiological, clinical abnormalities and deterioration. Other serious
events, such as suicide and aggression, are also often preceded by observed or reported changes in a
person’s behaviour or mood that can indicate deterioration in their mental state.
Early identification of deterioration may improve outcomes and decrease interventions required to
stabilise patients whose condition deteriorates in a health service organisation.
The warning signs of clinical deterioration are not always identified or responded to appropriately.
The organisational and workforce factors that contribute to a failure to recognise and respond to a
deteriorating patient are complex and overlapping (Australian Commission on Quality and Safety in
Health Care, 2017)
NSG3RDP Semester One 2023
Task
In this assessment you are required to further explore the paediatric respiratory case study
introduced in topic one of your LMS and workshop materials for NSG3RDP/RDM.
You will be provided with an ISBAR handover and a National Observation Chart (NOC) for 5-yearold Rosie Jones. (These documents will be attached at the end of this instruction sheet)
Using the provided information and current academic literature please provide a response to the
following three questions.
Instructions
Please answer the following questions as instructed
• Question 1 (750 words)
The condition of your patient Rosie Jones described in the ISBAR handover, appears to be
changing. (Please refer to the attached documentation)
Using the information that you have identified from the NOC and the ISBAR case study
handover:
1. Discuss the possible causes of Rosie’s changing condition, supporting your
response with contemporary literature and the associated significant cues, signs
and symptoms listed in the case study.
2. Explain what possible further deterioration could occur for this patient, with a
detailed evidenced -based response.
(Please support your justification and rationales with quality peer-reviewed literature).
• Question 2 (750 words)
There are many tools that can be utilised when assessing paediatric patients. When
assessing a deteriorating child, accurate assessment is essential. Compare and contrast the
following methods of paediatric patient assessment and their appropriate applications for
the deteriorating patient.
1. Primary (ABCDE)
2. Head to toe assessment
(Please support your discussion with evidenced based literature).
• Question 3 (500 words)
A change in a patient’s heart rate, blood pressure, temperature and respiratory rate can all
be an indication of clinical deterioration. It has been suggested that a changing respiratory
rate is the earliest indication of clinical deterioration and yet it is often not measured
correctly, or not measured at all. Using evidence-based literature to support your
arguments:
1. Discuss why a changing respiratory rate is an important indicator of clinical
deterioration.
2. Explain how the respiratory rate can be measured reliably and accurately in Rosie.
NSG3RDP Semester One 2023
**Discussions are to be supported with relevant and contemporary literature.
**References: Reference list and appendices are excluded from the word count.
**References to be no older than ten years
**10% word limit allowed.
Resources
Australian Commission on Quality and Safety in Health Care. (2017). National Quality and Safety
Health Care Standards Edition Two. Retrieved from
https://www.safetyandquality.gov.au/wp-content/uploads/2017/11/National-Safety-andQuality-Health-Service-Standards-second-edition.pdf
GENERAL ASSESSMENT REQUIREMENTS
SUBMITTING WRITTEN WORK WITH TURNITIN
Turnitin is a web-based text-matching software system used at La Trobe University to assist you in
writing your assignments and checking for similarity with existing published work. Please remember to
allow adequate time to submit your assignment to Turnitin. It is your responsibility to have your
assignment submitted by the assessment due date. Not receiving an originality report is not an
acceptable reason for requesting an assignment extension unless it is a required part of the assessment.
POLICIES, PROCEDURES AND GUIDELINES
The University has a comprehensive policy framework to which both staff and students must adhere.
You should familiarise yourself with those policies, procedures, and guidelines likely to affect you
especially the following:
• Academic Integrity
• Academic Progress Review
• Assessment Policy
• Adjustments to Assessment, including extensions to submission dates and Special Consideration
• Validation and Moderation, including applications for review and re-mark
ADJUSTMENTS FOR ASSESSMENT
You may be affected by a range of adverse circumstances while you are preparing for or undertaking an
assessment task. There are avenues for adjustments to your assessment depending on the
circumstances you face. For more detailed information refer to the Assessment Procedure –
Adjustments.
REQUEST AN EXTENSION OF TIME TO SUBMIT AN ASSIGNMENT TASK
Where you know in advance that you will not be able to submit an assessment task by the due date due
to adverse circumstances that have affected you during the preparation of the task, you will need to
request an extension of time to submit. This must be done at least three days prior to the due date.
NSG3RDP Semester One 2023
Penalties normally apply if you submit an assessment after the due date. Poor time management is not
an acceptable reason for an extension.
To apply, go to https://www.latrobe.edu.au/students/admin/forms/request-an-extension/request
SPECIAL CONSIDERATION
If you have experienced serious short term, adverse and unforeseen circumstances that substantially
affect your ability to complete an assessment task to the best of your potential, you may be eligible to
apply for Special Consideration. To do this or find more information, go to
http://www.latrobe.edu.au/special-consideration
Late submission
There are policies and procedures to guarantee fair, consistent, and transparent treatment of late
submission of assessment tasks provide equity around extensions to submission dates and penalties
associated with not submitting assessment by the due date and time.
https://intranet.latrobe.edu.au/teaching-and-learning/teaching-support-and-tools/assessment-policy
NSG3RDP Semester One 2023
| School of Nursing & Midwifery: NSG3RDP/NSG3RDM Assessment One | ||||||
| CRITERIA | Excellent (> 80 %) | Very good (70% – 79%) | Good (60% – 69%) | Fair (50% – 59%) | Poor (<50%) | MARK |
| Question One Discusses the possible causes of Rosie’s changing condition Explains what possible further deterioration could occur USE OF LITERATURE TO SUPPORT DISCUSSION (35% of total mark) |
28 + marks Clearly and consistently discuss possible causes of the Rosie’s changing condition Clearly and consistently explains what possible further deterioration could occur Demonstrated an excellent understanding of links between the necessary concepts. Demonstrated clear and consistent evidence of critical appraisal of reference material Evidence of synthesis of information and logical development of arguments |
24 – 27 marks Clearly and mostly consistently discuss possible causes of the Rosie’s changing condition Clearly and mostly consistently explains what possible further deterioration could occur Demonstrated a very good understanding of links between the necessary concepts. Demonstrated some evidence of critical appraisal of reference material Some evidence of synthesis of information and logical development of arguments Literature predominantly used effectively to support key ideas |
21 – 23 marks Good but inconsistent attempt to consistently discuss possible causes of the Rosie’s changing condition Good but inconsistent attempt to consistently explain what possible further deterioration could occur Demonstrated good understanding of links between the necessary concepts. Demonstrated inconsistent evidence of critical appraisal of reference material Inconsistent evidence of synthesis of information and logical development of arguments Literature inconsistently used to support key ideas |
18 – 20 marks Fragmented and inconsistent attempt to discuss possible causes of the Rosie’s changing condition Fragmented and inconsistent attempt to explain what possible further deterioration could occur Demonstrated limited understanding of links between the necessary concepts. Demonstrated limited evidence of critical appraisal of reference material Limited evidence of synthesis of information and logical development of arguments Literature poorly used to support key ideas |
<17 marks Demonstrated lack of understanding of possible causes of the Rosie’s changing condition Demonstrated lack of understanding of what possible further deterioration could occur Demonstrated lack of understanding of links between the necessary concepts. No evidence of critical appraisal of reference material No evidence of synthesis of information and logical development of arguments Overreliance on direct quotes Key ideas not supported by the literature |
/35 |
NSG3RDP Semester One 2023
| Question Two Compares and contrasts 1. Primary (ABCDE) 2. Head to toe assessment USE OF LITERATURE TO SUPPORT DISCUSSION (35% of total mark) |
28 + marks Clearly and consistently compared the two methods of assessment Demonstrated an excellent understanding of links between the necessary concepts. Demonstrated clear and consistent evidence of critical appraisal of reference material Evidence of synthesis of information and logical development of arguments |
24 – 27 marks Clearly and mostly consistently compared the two methods of assessment Demonstrated a very good understanding of links between the necessary concepts. Demonstrated some evidence of critical appraisal of reference material Some evidence of synthesis of information and logical development of arguments Literature predominantly used effectively to support key ideas |
21 – 23 marks Good but inconsistent attempt to compare the two methods of assessment Demonstrated good understanding of links between the necessary concepts. Demonstrated inconsistent evidence of critical appraisal of reference material Inconsistent evidence of synthesis of information and logical development of arguments Literature inconsistently used to support key ideas |
18 – 20 marks Fragmented and inconsistent attempt to compare the two methods of assessment Demonstrated limited understanding of links between the necessary concepts. Demonstrated limited evidence of critical appraisal of reference material Limited evidence of synthesis of information and logical development of arguments Literature poorly used to support key ideas |
<17 marks Demonstrated lack of understanding of the two methods of assessment Demonstrated lack of understanding of links between the necessary concepts. No evidence of critical appraisal of reference material No evidence of synthesis of information and logical development of arguments Overreliance on direct quotes Key ideas not supported by the literature |
/35 |
| Question Three Discusses why a changing respiratory rate is an important indicator of clinical deterioration. Explains how the respiratory rate can be measured reliably and accurately USE OF LITERATURE TO SUPPORT DISCUSSION |
20 + marks Clearly and consistently discusses the changing respiratory rate significance and explains the means of achieving assessment accuracy Demonstrated an excellent understanding of links between the necessary concepts. Demonstrated clear and consistent evidence of critical appraisal of reference material |
17.5-19.5 marks Clearly and mostly consistently discusses the changing respiratory rate significance and explains the means of achieving assessment accuracy Demonstrated a very good understanding of links between the necessary concepts. Demonstrated some evidence of critical appraisal of reference material Some evidence of synthesis of information and logical |
16-17 marks Good but inconsistent attempt to consistently discuss the changing respiratory rate significance and explain the means of achieving assessment accuracy Demonstrated good understanding of links between the necessary concepts. Demonstrated inconsistent evidence of critical appraisal of reference material |
13 – 15 marks Fragmented and inconsistent attempt to discuss the changing respiratory rate significance and explain the means of achieving assessment accuracy Demonstrated limited understanding of links between the necessary concepts. Demonstrated limited evidence of critical appraisal of reference |
<12.5 marks Demonstrated lack of understanding of the significance of the respiratory rate or the means of achieving accuracy. Demonstrated lack of understanding of links between the necessary concepts. No evidence of critical appraisal of reference material |
/25 |
NSG3RDP Semester One 2023
| (25% of total mark) | Evidence of synthesis of information and logical development of arguments |
development of arguments Literature predominantly used effectively to support key ideas |
Inconsistent evidence of synthesis of information and logical development of arguments Literature inconsistently used to support key ideas |
material Limited evidence of synthesis of information and logical development of arguments Literature poorly used to support key ideas |
No evidence of synthesis of information and logical development of arguments Overreliance on direct quotes Key ideas not supported by the literature |
|
| ACADEMIC INTEGRITY & FORMATTING (5% of total mark)) |
5 marks Correct use of APA V7 in text and end-text format. Use of submission template and specified formatting. No spelling typing or grammatical errors Within 10%-word limit. |
4 marks Correct use of APA V7 in- text and end-text format, minor errors. Use of submission template and specified formatting. Minor spelling, typing & grammatical errors. Within 10%-word limit. |
3 marks Occasional errors in APA V7 format. Use of submission template and specified formatting. Minor spelling, typing & grammatical errors. Within 10%-word limit |
2 marks References provided but incorrect use of APA V7 format. Use of submission template. Inconsistent use of specified formatting. Consistent spelling, typing and grammatical errors. Within 10%-word limit |
≤1 mark Referencing does not adhere to APA V7 format. Specified presentation & formatting not used. Spelling, typing and grammatical errors throughout the paper which impact on fluency and coherency. Exceeds 10%-word limit. |
/5 |
| /100 |
NSG3RDP Semester One 2023
Attached documentation
Handover ISBAR
Setting: Paediatric Ward
Time frame: 2100 hrs
| Patient identification | Rosie Jones DOB 23/11 UR 8679543 5-year-old female Social history Lives with family in Numurkah |
| Situation/Setting the scene Initial Investigations/treatment |
Rosie has been brought into the emergency department by her mother. Given that it is Saturday evening Rosie’s mum Jane was not able to take her to their usual GP. Rosie has been unwell for a few days with earache and cold-like symptoms. She has not been her usual active and cheerful self, particularly in the last 24 hours. Jane took Rosie to the GP two days ago and she was commenced on oral antibiotics for a possible otitis media. In ED: Rosie to be admitted to paediatric ward Oxygen if saturation below 92% Salbutamol via spacer 3 doses 20 minutely. Review 10-20 minutes after 3rd dose. If improving reduce frequency, if no change continues 20 minutely. Ipratropium via spacer 20 minutely in first hour. Oral prednisolone 1mg/kg/d. Half hourly observations Fluids and diet as tolerated Monitor urine output |
| Background/Past medical and surgical history Medications Allergies |
Born at term All immunisations up to date Ear infections x 4. Grommets inserted 6 months ago Weight 18 kgs Amoxicillin 90mgs TDS No known drug allergies |
NSG3RDP Semester One 2023
| Assessment information | First Assessment in ED at 1600hrs: Airway patent Patient verbalising RR 36 Generalised inspiratory and expiratory wheeze Pale HR 120 Temp 36.6 AVPU Alert, quiet cuddling into Sherin Audible wheeze Mild increase in respiratory effort. Slight evidence of accessory muscle use Nil rib recession Speaking in short phases Decreased intake and output Not wanting to engage with nurse when questioned Second assessment Now at 2100 hrs: CNS Quiet and withdrawn. Occasional grunting (Mother in attendance. Resting in chair beside bed) CVS HR 140 Pale Capillary refill<3secs Resp Quiet chest Decreased air entry to bases Generalised inspiratory and expiratory wheeze RR 42 O2sat 93% Moderate increase in respiratory effort. Moderate evidence of accessory muscle use Marked rib recession Slight nasal flaring Not speaking to nursing staff Metabolic Temp 37 GIT Minimal intake Renal Has not voided since admission to surgical ward |
| Recommendations/ Important considerations |
Hourly observations overnight. Ongoing medications as per medication chart. Oxygen if O2sat below 92% |
| Included documentation National patient observation chart |
NSG3RDP Semester One 2023